Ever heard of the term “baby blues”?

It refers to symptoms of post-partum depression experienced by a new mother shortly after birth, as they face a steep learning curve in managing and caring for a newborn.

However, some women may also experience signs of depression during pregnancy – a condition known as prenatal depression.


What are the signs of prenatal depression?

Dr Helen Chen, Senior Consultant and Head of Mental Wellness Service at KK Women’s and Children’s Hospital, explains, “The symptoms of prenatal depression are quite similar to that of depression at any time of a woman’s life. They include the following over at least a two-week duration:


• Low mood or tearfulness
• Poor sleep
• Poor appetite
• Loss of interest
• Loss of concentration
• Negative thinking
• Excessive self-blame or guilt
• Agitation or psychomotor retardation (ie slowing down of thought processes and physical activity)
• Loss of energy
• Sense of hopelessness
• Suicidal feelings


She goes on to elaborate, “However, prenatal depression is different in the sense that the negative thoughts are related to baby and motherhood, such as ‘I’m not good enough for this baby’ or ‘I am a bad mother – I can’t feel any love or excitement for this baby growing inside’.”


How do you differentiate prenatal depression from a case of “hormonal changes” and other pregnancy symptoms such as fatigue or general anxiousness?

Dr Chen points out that simply feeling fatigued, which is common in pregnancy, or anxious about the impending transition from couplehood to parenthood, does not equate to having prenatal depression. “Women with prenatal depression have a sustained feeling of low mood or loss of interest, as well as the symptoms described above, that last two weeks or longer,” she explains, “and these symptoms affect their functioning.”


Also, unlike pregnancy symptoms which end with the birth of the baby, women with prenatal depression tend to be more vulnerable to recurrence of depression.


Why do some women seem to embrace pregnancy and motherhood with no problems at all while others feel disassociated with the baby and the pregnancy?

For some women, the pregnancy may have been unplanned or unwelcomed. They may have difficulties accepting or adjusting to the pregnancy and the natural psychological defense is to detach themselves from the baby and the pregnancy. Dr Chen elaborates that for cases of mild prenatal depression, “the pregnant woman may have difficulties growing attached to the developing foetus and may not have any feelings towards the baby”. In severe cases of prenatal depression, some women may deny the pregnancy – and reject the baby – altogether. She advises these mothers-to-be to seek help in making the transition to motherhood, so as to ensure the development of a healthy bond between mother and baby.


Prenatal depression is not unique to unplanned pregnancies only. Even planned pregnancies can give rise to depressive symptoms, such as if the pregnancy is a complicated or stressful one. Stress factors affecting the sufferer may not be directly related to the pregnancy or the baby. For example, the mother-to-be may be experiencing relationship difficulties, undergoing a career change for the sake of increasing family finances, or moving to a bigger house to accommodate the new arrival. Coupled with general pregnancy symptoms like fatigue and nausea, these external stress factors may take a toll on the pregnant woman. This can be disconcerting to the mother-to-be who may have expected pregnancy to be a joyous experience. Instead, she feels depressed and detached from her pregnant body and the baby growing inside her.


Women who have undergone the physical and emotional trial of fertility treatment may also be prone to additional stress and anxiety, especially if they are terrified of losing their precious baby now that they have managed to conceive. Similarly, women who have previously miscarried may be more vulnerable to depression during subsequent pregnancies.


How can an expectant woman prevent the onset of prenatal depression?

Dr Chua Tze-Ern, Associate Consultant Psychiatrist, Mental Wellness Service at the KK Women’s and Children’s Hospital, advises, “Despite one’s best efforts, there may be factors that cannot be fully anticipated or controlled, such as family history, hormone fluctuations, physical illness, antenatal complications and social problems.” This makes it difficult for any woman to completely eliminate her risk of prenatal depression.


However, expectant mothers can make efforts to reduce their stress levels and thus, their risk of prenatal depression. “Mothers-to-be can try to prepare physically and emotionally for parenthood,” explains Dr Chua, “such as managing personal expectations of motherhood, reinforcing the marital relationship, learning how to feed, bathe and change a baby, and buying childcare supplies beforehand.”


What can a husband do to help?

Dr Chen emphasises that family support, including support from the husband, is very important.

She cautions husbands against dismissing their wife’s unstable emotional state as “just hormonal changes”, without carefully assessing and discussing their spouse’s condition. “One common difficulty patients often tell me is that their husbands don’t understand or believe them and just tell them to snap out of it. This can be particularly difficult as it lowers her self-esteem and makes her feel worse.” Even worse, “the stigma of mental illness often leads the mother to keep her suffering to herself”, says Dr Chen, “because everyone around her expects her to be happy and excited about her baby.”


The husband can show his love and support by encouraging his wife during the more difficult stages of pregnancy (such as the first and final trimesters), and talking through her fears about the impending transition to motherhood. “He can also help to look out for the early symptoms of depression and get the afflicted mother to seek medical attention early before the depression starts to deepen”, suggests Dr Chen.


In addition, seeking treatment early will also enable the expectant mother to reduce her chances of postpartum depression when the baby arrives.


Maybe Baby would like to thank Dr Helen Chen, Senior Consultant and Head of Mental Wellness Service and Dr Chua Tze-Ern, Associate Consultant Psychiatrist, Mental Wellness Service, at KK Women’s and Children’s Hospital, for their inputs.

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